Provider Demographics
NPI:1780265231
Name:GRGICH, LAURA LYNN (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:GRGICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:GRGICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:83 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1512
Mailing Address - Country:US
Mailing Address - Phone:650-784-8067
Mailing Address - Fax:
Practice Address - Street 1:222 W 39TH AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-4364
Practice Address - Country:US
Practice Address - Phone:650-573-2671
Practice Address - Fax:650-573-2696
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351587163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency